Statistical differences were found when calculating the BMI of the participants, with 48% of them falling within the normal range and the lowest percentage, 36%, falling within the high normal range. The classification was based on CDC standards [1].
The percentage of male smokers among the participants was 68%, with the highest number of packets smoked annually ranging from 50 to 100 packets. Despite awareness campaigns about the negative impact of smoking on COPD attacks and the deterioration of the condition, the mortality rate increases to 8 out of 10 among smokers with chronic obstructive pulmonary disease [13].
The majority of participants were elderly [aged 70 − 61], and due to their advanced age, they may suffer from other disorders such as hypertension, and cardiac disorders, all of which are complications of COPD. This is confirmed by a study by Anastasia and colleagues in 2023, which investigated the prevalence of heart and vascular diseases among patients with obstruction and their impact on exacerbation, quality of life, and survival rate among patients with chronic obstructive pulmonary disease. It emphasized that the risk of developing acute cardiovascular diseases increases during exacerbation of chronic obstructive pulmonary disease and remains high for a long period even after recovery [14].
Despite the majority of participants consuming moderate daily meals of three servings, 40% suffer from acid reflux. This is due to their lack of attention to the nature of food, as highlighted by Carolyn Newberry and her colleague in an article published in 2019, emphasizing the importance of paying attention to the type of food and avoiding acidic, sugary, and fatty foods due to their negative impact and increased likelihood of acid reflux [15].
In our study, there is no significant correlation between GERD and gender, as the incidence rate in the survey participants, whether male or female, is 50%. However, there is a weak correlation between GERD and age, with the prevalence rate increasing with age. A study conducted by Hashem in 2016 in an Iranian journal showed an increase in GERD prevalence among women, especially those over the age of 50. The study involved 803 patients, 60% of whom were women [16].
Most previous studies relied on evaluating the condition of COPD patients according to the CAT scale, revealing that 60% of the participants [20 − 10] had a moderate condition. The patients experience coughing with sputum most days, which hinders their daily activities on some days of the week, accompanied by severe exacerbations once or twice a year. However, they can walk and climb stairs slowly. This is followed by 24% [20–30] with severe condition, where the severity of symptoms prevents patients from performing their daily activities. They experience difficulty breathing while walking and talking, and have trouble sleeping at night, making them constantly anxious. Then, 9% with a condition greater than 30, which is very severe, prevents patients from performing any activity, even bathing, and they also have difficulty leaving the house or performing simple household chores. Consequently, they continue to bedridden for a longer period. The lowest percentage, 7%, indicates minimal symptoms overall with slight suffering such as coughing for several days, shortness of breath during exercise, and the need for rest when climbing mountains [5, 17].
There is a relationship between COPD exacerbations and GERD, as a moderate inverse relationship indicates that frequent COPD exacerbations increase the likelihood of GERD. This was shown in a study conducted in 2022 and 2015 [18, 19].
Additionally, there is a negative impact of smoking on COPD exacerbations, especially with increasing annual cigarette consumption. 86% of participants admitted to not quitting smoking despite suffering from recurrent symptoms that hinder their daily lives. The World Health Organization has also indicated an increase in morbidity and mortality from COPD among smokers [20].
We notice a correlation between gender and the severity of COPD exacerbations. A study conducted on 323 COPD patients (25 obese, 228 non-obese) in 2016 showed that males are considered a protective factor against severe exacerbations requiring hospitalization [21].
In our study, 48% of the participants reported being within the normal weight range. As stated in the previous article [21], COPD patients who are not obese are more likely to be hospitalized by 1.6 times due to severe exacerbations.
Wang and colleagues conducted a study in 2023 [22], confirming the protective and preventive effect of weight gain and obesity on exacerbations, and weight loss leading to deterioration of lung function. Another cross-sectional study [23] of COPD patients suffering from weight gain and obesity showed a protective role in exacerbating the morbidity rate among patients [24].
Study's limitations:
This is a cross-sectional survey study, thus recall bias is common. In addition, unable to determine casualty. Furthermore, subjective assessments may not be as accurate as objective.